Yorke Ekua, Stafford Sara, Holmes Daniel, Sheth Sachiv, Melck Adrienne
Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Department of Endocrinology, Surrey Memorial Hospital, Surrey, British Columbia, Canada.
Int J Surg Case Rep. 2015;7C:141-4. doi: 10.1016/j.ijscr.2015.01.013. Epub 2015 Jan 10.
Approximately 35% of cases of Conn's syndrome (primary aldosteronism) result from a solitary functioning adrenal adenoma, and these patients are best managed by adrenalectomy. Postoperative hypoaldosteronism after unilateral adrenalectomy is uncommon.
We present a case and literature review of hypoaldosteronism after unilateral adrenalectomy for Conn's syndrome, which demonstrates the insidious and sometimes delayed presentation.
In this clinical case we summarize the previously published cases of post-adrenalectomy hypoaldosteronism based on a PUBMED and EBSCOhost search of all peer-reviewed publications (original articles and reviews) on this topic. A few cases of aldosterone insufficiency post-adrenalectomy for Conn's syndrome were identified. The etiological factors for prolonged selective suppression of aldosterone secretion after unilateral adrenalectomy remain unclear.
It is important to be aware of the risk of postoperative hypoaldosteronism in this patient population. Close postoperative follow-up is necessary and strongly recommended, especially in patients with certain risk factors. Patients may need mineralocorticoid supplementation during this period.
约35%的Conn综合征(原发性醛固酮增多症)病例由孤立性功能性肾上腺腺瘤引起,这些患者最好通过肾上腺切除术进行治疗。单侧肾上腺切除术后发生醛固酮减少症并不常见。
我们报告一例Conn综合征患者单侧肾上腺切除术后发生醛固酮减少症的病例并进行文献复习,该病例显示了该病隐匿且有时延迟出现的特点。
在本临床病例中,我们基于对PUBMED和EBSCOhost上所有关于该主题的同行评审出版物(原创文章和综述)的检索,总结了既往已发表的肾上腺切除术后醛固酮减少症病例。确定了几例Conn综合征患者肾上腺切除术后醛固酮分泌不足的病例。单侧肾上腺切除术后醛固酮分泌长期选择性受抑制的病因尚不清楚。
认识到该患者群体术后发生醛固酮减少症的风险很重要。术后密切随访是必要的,强烈建议进行,尤其是对有某些危险因素的患者。在此期间患者可能需要补充盐皮质激素。